Making Healthcare Costs Transparent
From business to government to essential services like banking and healthcare, transparency is the name of the game in our current cultural climate. People crave honesty and uprightness from anyone or anything they are invested in, and understandably so. In healthcare, transparency is truly the future – but unfortunately, it’s only a rare few who understand and act upon that principle. When a healthcare consumer has no idea what services cost at his hospital or physicians group, it’s a dismal reality. All he knows is that he gets sick, he gets treated, and he hopes for the best.
But in the health plan solution we offer, direct contracting, consumers get the exact opposite experience; in other words, they get the transparency they rightfully hope for as a healthcare consumer. That’s because their employer agrees with us upon a set of rates, and both sides are contractually bound to those rates. The employer, normally through its human resources department, makes it clear to the members of the plan what the costs are and we are openly communicating with all parties along the way.
From the healthcare consulting group (that’s us), to the human resources department, to company management and of course to the employees, we are all on the same page when it comes to healthcare costs; that’s the beauty of the direct contracting model. It’s an ecosystem that works really well for an organization that is trying to reduce healthcare costs while keeping the lines of communication open with its employees.
Now, we know what you might ask: “What if someone has an atypical situation with their healthcare?” Well, good news: If there are issues with an employee’s plan – say, there’s something strange, tricky or otherwise unusual about the care he requires for a condition – we are not afraid to get involved. We encourage employers to alert us in these situations, so we can intervene on their behalf to reduce costs for the employee. That’s a whole new layer of transparency, isn’t it?
For questions on reducing your organization’s health plan costs through the direct contracting healthcare model, contact GM&A today. We will be happy to provide you with more information.
A Solution for the Obamacare Repeal
As we all know, Republicans on Capitol Hill are currently moving forward with long-anticipated plans for repealing and replacing the Affordable Care Act, more commonly known as Obamacare. Depending on who you listen to, this could mean 1) the end of the end for Americans who have health insurance through the individual Obamacare exchanges in their states, or a 2) new beginning for the Americans who were already covered by employer-sponsored health plans, but were angered over the rising premiums that private insurers have imposed over the past several years.
Which one is it?
So, which one is it? Maybe it’s a little bit of both – and maybe, just maybe, neither side has the answer. “The ACA made changes in every part of the health care system,” said Larry Levitt, senior vice president at the Kaiser Family Foundation, of the Affordable Care Act. “Virtually everyone has been touched by the ACA.” That’s true – and that’s why changes to it could bring about changes that are both positive and negative.
What’s the Solution?
For employers who are struggling to make a decision about what health plan option should be implemented as our lawmakers overhaul the current government solution, we suggest direct contracting. Direct contracting is a private employer health plan solution that is tailor made for mid-sized to large organizations. It can be entirely customizable for an employers’ needs.
Here is just one example: If an employer wishes to continue covering part-time employees (employees who work 30 hours a week who were covered because of the Obamacare employer mandate), they can – and, they can do it more affordably by working with experts who know the healthcare market enough to help them hand-pick the providers in their network.
The Shopping Cart Method
Direct contracting allows employers to choose which aspects of the Affordable Care Act they want to keep. In addition to the employer mandate aspect of Obamacare, employers can choose other parts of the law they wish to retain – such as keeping children on their parents' health plans through age 26. Time has shown this to be one of the most popular provisions of Obamacare, and employers who recognize that are free to make it part of their customized corporate health plan if employee demand requires it. This is the “shopping cart” method of corporate health plans – keeping what you like, passing on what you don’t like – and it works.
Direct contracting can be a welcome solution for the repeal of Obamacare, and employers need to investigate it before a full repeal takes place. To learn more about direct contracting from a firm that provides it as a solution, contact GM&A to request a complimentary health plan consultation.
Making the Fate of the ACA Irrelevant to You
With a new President, and now a new Secretary of Health and Human Services, we’re continuing to hear that the Affordable Care Act will be repealed and replaced – but, if you listen to the people with mouthpieces, “portions” of the act will be retained. Often, they’re speaking of the popular, consumer-friendly aspects of the law such as children staying on their parents’ plans until age 26, etc. But what about the less talked-about parts of the ACA? Here are some aspects of the ACA that lawmakers are considering the fate of:
- Cost-sharing subsidies, AKA the money that goes to insurers to help protect low-income healthcare consumers from paying too much out of pocket
- The individual mandate, otherwise known as the ACA’s requirement that every American obtain health insurance or face a tax penalty
- Consumer protections in the ACA, which are the portions of the legislation that make it a bit too easy for Americans to game the system – in other words, wait until they get sick or injured to sign up for a healthcare plan (and on the flip side, make it too easy for them to cancel that plan once they feel better)
Congress and the new administration has a lot to consider when it comes to repealing and replacing the ACA – but as a consumer, employer or human resources person tasked with deciding how you and those in your organization obtain healthcare, you can avoid having to worry about the fate of the act altogether. How? By finding a privately funded alternative to provide the healthcare coverage you need.
Direct contracting is a completely private solution to the healthcare coverage needs of individuals, public employers, private employers and even non-profit organizations. It can cover the people you’re responsible for affordably and easily, with less red tape and lower overhead costs for those in charge. This is the healthcare solution you’ve been waiting for. To learn more about direct contracting, contact GM&A Healthcare Consultants at (325) 224-3245. We will be glad to answer your questions!
New Year, New Health Plan
Now that it’s 2016, we are getting inquires on getting started with direct contracting during the open enrollment period – and that’s a good thing, because the beginning of the year is the best time to inquire. Every healthcare program requires some time to implement, and direct contracting is no exception. The truth is, if a company is serious about getting started with direct contracting for its employer health plan, then everyone should be prepared for the timeline to be up to six months in duration, from start to finish. Keep in mind, the steps include:
Consultation: The first consult is an important appointment that provides the potential client with all the necessary information on the direct contracting healthcare model. If you are interested in being a client, you want to schedule your consultation as early in the new year as possible.
Analysis: Once the client is on board, we perform an analysis of the company’s healthcare data – namely, examining the number of employees and dependents requiring coverage and analyzing their past claims data. This is important because it helps us identify the most appropriate providers to approach with contract proposals.
RFP: Next, we enter the request for proposal (RFP) stage. This is when the right providers are identified and approached with proposals on contracting with your company; it is the stage where the actual healthcare services are secured.
Processing: We then obtain signatures and process the contracts with each provider, ensuring that they are legally binding contracts for the enrollment year.
Preparation: Finally, we prepare for open enrollment. This is a process that requires us to obtain the most up-to-date data on your employees and their dependents so we can get them enrolled during the eligibility period.
As you can see, it takes months to put a complete employer health plan program together. That’s why it is in every client’s best interests to begin the process at the beginning of the year. It’s not too late to inquire now, so we can begin creating and establishing your new company health plan. Contact GM&A to learn more today!
What Will a New HHS Secretary Mean for Your Company Health Plan?
As those who are plugged in to current events may be aware, President-Elect Donald Trump has chosen an outspoken critic of the Affordable Care Act to be the next Secretary of Health and Human Services. Congressman Tom Price (R-GA) is an orthopedic surgeon who has his own decided positions on health care reform – positions that some say may “heal” the weakest parts of the Affordable Care Act.
What are those weak spots? Remember, the ACA will most likely account for $1.8 trillion in new spending over the next decade, while only covering approximately 31 million of the 48 million uninsured Americans. That was not necessarily by design, of course; it is mostly due to employers being forced to restructure due to the law, followed by the reality that around 9 million fewer Americans have enrolled in their state exchanges than the government anticipated. Meanwhile, median health insurance premiums have shot up 116% since 2012. Clearly, there is a lot about the ACA (Obamacare, for those who prefer the colloquial term) that needs to be reformed – so this new cabinet choice is intriguing. But will it be effective?
No one can say for sure, of course. And that’s why, no matter who is appointed to the new presidential cabinet and what their positions are when it comes to regulation and subsidies, companies still need to take the appropriate measures to protect their bottom lines and serve the employees who keep their operations working. For healthcare, one of the best ways to do this is with direct contracting, a model that involves implementing contracts with healthcare providers rather than insurance carriers. If a new HHS secretary ushers in big changes that make a positive impact for employers, that’s great – but for employers that have made smart choices for the health plans they offer, the benefits will be even greater. Learn more about it by calling GM&A at (325) 224-3245.
Obamacare Open Enrollment: Should You Sign Up?
According to the Centers for Medicare and Medicaid Services, over 1 million Americans signed up for health insurance plans on the federal government’s HealthCare.gov platform during the first two weeks of this year’s open enrollment period. That includes 250,000 new Obamacare consumers and over 750,000 renewing their current Obamacare plans. With that in mind, should you enroll in your state’s Obamacare exchange this open enrollment period? That’s a decision only you can make for yourself, but what we can tell you is this: If you don’t have access to a health plan through your employer, Obamacare isn’t necessarily the only option you have for coverage.
What if you could contract directly with healthcare providers, rather than worrying about the foibles of the mixing government subsidies with the health insurance industry altogether? It is possible, not just for employers but also for individuals in some cases – and direct contracting is what makes it possible. Direct contracting is a service that people can take advantage of if they are interested in exploring their options for healthcare coverage, not just to save costs, but also in order to gain more control over their own care. It can be especially useful for people who need to see specialists, or people who require ancillary healthcare supplies to support certain conditions: wheelchairs, shower chairs, walkers, etc. If you speak with a healthcare consultant who facilitates direct contracting services, you are under no obligation to proceed with contract negotiations – but you just might find yourself excited about the money you can save.
To find out if you can cut your personal healthcare costs with direct contracting, contact GM&A Healthcare Consultants to request a complimentary consultation. You’re under no obligation to purchase; this can be an informative meeting to discuss your personal healthcare expenses and ways to address them. If Obamacare is something you’d rather avoid, then there’s no better time to make this appointment.
Alternatives to Traditional Company Health Plans: Now’s the Time
As you know, a lot of changes have come about in our nation over recent days – leading to some volatility in the American stock market, global financial markets and of course, the public discourse. Meanwhile, employers and their human resources professionals still have organizations to run. They can’t afford to stop and reflect for too long; even in the eye of the storm, they have to keep moving forward. Of course, one of the most urgent matters on their agendas this time of year is wrapping up their duties for the annual open enrollment.
No matter what happens to be going on in government, there’s no time to waste when it comes to improving your organization’s employee benefits – chief among them, the company health plan. As you know, there’s a lot of talk that the incoming presidential administration wants to “repeal and replace” the Affordable Care Act; maybe it will happen, maybe it won’t. Maybe it will only partially happen. If you’re an employer, you can’t afford to stand by and wait to find out.
Right now, before any sweeping changes are enacted, employers need to start looking into alternatives to save costs on their company health plans. For many of those employers, one of the most promising alternatives to traditional health plans will be direct contracting. Direct contracting is a service that is an alternative to traditional company health plans. It can bring about the money-saving changes your company plan needs without compromising on the care your employees receive. It sounds simple, because it is; all the best things are.
A winning campaign usually has a simple message, and ours is no exception: Corporate health plans are too expensive. With direct contracting, GM&A can help lower your company health plan costs while ensuring your employees receive uninterrupted care. If you’re interested in learning more, contact us to request a complimentary benefits consultation.
Privatizing Single Payer Healthcare
There are less than two weeks until the presidential election, and the final debate included some discussion on healthcare – specifically, which candidate would “repeal and replace” the Affordable Care Act and which one would simply amend the existing law. Remember, though: If the existing law were to be altered, the result would still be some form of a single payer system that would cost taxpayers just as much money as the ACA already does (whether it’s in the form of higher premiums for covered individuals or higher taxes across the board). Meanwhile, repealing and replacing is not as easy as it sounds. Either way, America has a hard road ahead of itself when it comes to perfecting its healthcare system.
In the meantime, we urge employers to look at the private market healthcare solution we offer at GM&A. It is almost a form of single payer, only the “payer” is a private entity that simplifies processes, lowers costs and improves care – not a government bureaucracy that complicates, charges and delays.
Our method, direct contracting, gives employers the opportunity to affordably cover their employees with healthcare plans that make sense for the organization and everyone in it. It is designed to make it easier for employers to comply with the existing Affordable Care Act, while still helping them drive down costs. It even gives them the ability to create a customized network of providers in their local area, as opposed to subjecting them to only one or two providers to choose from. No presidential candidate can feasibly promise that to anyone, but a private entity can; GM&A can.
We have a message for employers throughout the United States: If you are tired of the political back-and-forth on healthcare, contact GM&A to request a no-obligation health plan consultation. We will be happy to speak with you!
HR Malpractice | Failing to Do Right by the Company Can Cost Everyone
Everyone knows what the term “malpractice” means when it comes to the healthcare industry. But what about other fields – like human resources, for example? It is entirely possible to commit malpractice in a field like that, specifically if the HR administrator is failing to carry out due diligence to find services that are in the company’s best interests – and, the interests of the employees who are receiving those services. A perfect example of this is failing to make sure the company is paying for the most affordable and effective healthcare plans possible.
Why would an HR person do this? Often, the HR administrator works directly with a broker on setting up the company healthcare plan – and often, that broker is tied firmly to an insurance company. There’s nothing inherently wrong with that, but for the fact that the specific insurance company the broker is affiliated with will be sure to incentivize him heavily for getting them business. That means, of course, that the broker may recommend insurance carriers that:
- Charge more than the company can afford
- Don’t offer all the coverage options the company needs
- Don’t have enough providers in the company’s local area
…but the HR administrator will only know that if he or she carries out due diligence to find out what the specific insurance carrier can provide. If all the HR department does is meet with a broker, look at a single insurance carrier and negotiate for the lowest rates before signing on the dotted line on behalf of an entire company – well, that’s hardly in the best interest of the company or its employees. Failing to save the company money, failing to make sure employees get the right coverage…that’s HR malpractice.
Now, compare that to the experience of working with a healthcare consultant that is not tied to any specific insurance carrier. At GM&A, we give the HR administrators we consult the opportunity to reduce costs for the companies they work for by forming their own customized healthcare networks. The providers are in the company’s local area, and the plans are set up to cover the needs of the company based on its employees’ own past claims. And on a regular basis, we perform audits of our clients’ cases to make sure no one is being overbilled for care an employee receives. We don’t just help companies get set up with a healthcare plan; we also help them manage it.
Thinking outside the box takes some courage in any field, including human resources. Rather than committing HR malpractice, we at GM&A hope that HR professionals will keep an open mind and consider meeting with us to see what we can do for them. Contact GM&A at (325) 224-3245 to request more information or schedule a complimentary appointment at your location. We service employers throughout the United States.
Aetna Pulls out of Obamacare – What it Means for the Future
As you may have heard, the large insurance provider Aetna is the latest insurer to announce that it is pulling out of several Affordable Care Act state healthcare exchanges. Aetna withdrew from 11 states last week, leaving approximately 167,600 patients without healthcare coverage – many of them in rural areas where access to care was already compromised. In fact, Aetna’s decision has created another fascinatingly gloomy development: Pinal County, Arizona, has just become the first county in the nation to have no Affordable Care Act providers. Which county will be next? We are all but certain that more will follow.
Once again, we see that the Affordable Care Act is doing precisely the opposite of what it was designed to. It was implemented to give Americans healthcare coverage, and yet because of the costly impact it has on insurers and employers, the ACA is actually taking coverage away. If you thought we needed healthcare reform prior to 2009, look at the extent to which we need reform now. As you may know, we at GM&A Healthcare Consultants believe the path to that reform is our direct contracting health plan model.
When healthcare providers (not insurance companies, and certainly not government-implemented exchanges) compete for the business of employers who provide employee benefits, everyone wins. The employer wins by saving money, the employee wins by getting outstanding coverage from local providers that were chosen specifically for their network, and providers win because they get paid quickly and fairly. Direct contracting can and should be the future of American healthcare. It’s time to get on board this train now, because if the news about Aetna is any indication, the Affordable Care Act catastrophe is only posed to get worse.